Role of ureteric stents in relieving obstruction in patients with obstructive uropathy

The aim of this study is to evaluate the role of ureteric stents in relieving obstruction and improvement of kidney function in patients with obstructive uropathy. This study involved 138 patients with obstructive uropathy with age ranged from 2 months to 73 years. Patients classified into two groups: Group [I]: Includes 57 patients [41.3%], ureteric stents fixed to them; and Group [II]: Includes 81 patients [58.6%] managed by other treatment modalities. All patients underwent clinical assessment, Laboratory and radiologic investigations: At presentation and postoperative. These included: Complete urine analysis, urine culture and sensitivity, serum creatinine, serum urea nitrogen, serum uric acid, serum sodium [Na], serum potassium [K], Fasting blood glucose level and blood picture and plain X-ray [KUB], abdominal ultrasonography [US], diuretic renography and retrograde pyelography. Renal glomerular filtration rate [GFR] was used as an indicator for improvement of renal function after fixation of ureteric stent. In group I: 56 [71.8%] kidneys showed significant recovery compared to 61 kidneys [66.3%]. In group II, there is statistically significant relation between renal perfusion and renal recovery [P < 0.004], statistically significant relation between parenchymal thickness and recovery in both groups [P < 0.0002], statistically significant relation between degree of corticomedullary differentiation and recovery [P < 0.0003] and statistically significant relationship between hemoglobin levels at presentation and the recoverability [P < 0.002]. The predictors of renal recoverability revealed that ureteral stents alone can help in regaining renal function and significant improvement of clinical condition in patients with obstructive uropathy.

Tracheostomy operation one-year prospective study

Prospective study of the tracheostomy operations that have been done at Mosul Teaching Hospital, Iraq. We evaluate 80 tracheostomy operations performed in the period from October 2007 to September 2008. Out of 80 patients, 56 were males [70%] and 24 were females [30%]. The age of patients ranged from 6 months to 86 years. Upper airway obstruction was found to be the commonest indication for tracheostomy [60%] and malignancy of the larynx was the predominant single cause of the upper airway obstruction. Elective tracheostomy was performed for 43 patients [53.75%] while emergency tracheostomy for 37 patients [46.25%]. Local anaesthesia was used in 43 patients [53.75%] while general anaesthesia was used in 37 patients [46.25%]. The most common complication was wound infection forming [38.09%] of all complications. More than half of the patients for whom tracheostomies done were below the age of fifty years. Upper airway obstruction is the most common indication for tracheostomy followed by assisted ventilation. Elective tracehostomy dominates over emergency one. There is a significant statistical difference between elective and emergency operations with respect to the complications. There is no significant statistical difference between local and general anaesthesia with respect to the complication. Wound infection is the most common complication encountered in this study

Advanced tissue characterization in non-ischemic cardiomyopathies using contrast-enhanced cardiac magnetic resonance imaging

Cardio-vascular magnetic resonance imaging [CMR] can be used to obtain integrated information on both cardiac function and on advanced tissue characteristics. Using contrast-enhanced techniques, highly diagnostic information on tissue viability, inflammatory changes, and on storage diseases can be obtained within a 45-minute examination. The combination of functional information [using steady-state free precession sequences cine techniques], assessment of myocardial edema [using T2 based techniques], of reversible injury [for example its inflammatory diseases; using T1-based techniques], and irreversible injury [for example in infarction and regional fibrosis, using late gadolinium enhancement techniques] allows disease-specific and prognostic information to be obrained in patients with non-ischemic cardiomyopathy. Contrast-enhanced CMR allows the accurate diagnosis of non-ischemic cardiomyopathies, identification of primary and secondary cardiomyopathies, and can be used to guide therapy, thus avoiding the need for invasive measures such as endomyocardial biopsy in many cases

Post tonsillectomy bleeding a review of 500 cases

To study the incidence of bleeding following tonsillectomy, its relation to age and sex, and the effect of different hemostatic techniques on the occurrence of bleeding. Five hundred tonsillectomies were performed in the ENT department at Al Zahrawi Teaching Hospital in Baghdad, over seven years. The incidence of post tonsillectomy bleeding and the effect of age, sex, method of hemostasis and time of bleeding were studied. The incidence of major post-tonsillectomy bleeding was 1.4%, and there was an increased incidence in patients over the age of twenty. Secondary bleeding was more common in females. Eighty percent of reactionary bleeding happened in the first six hours after surgery, and most of secondary bleeding occurred toward the end of the first week. We noticed increased severity of pain prior to secondary bleeding in a number of cases. Tonsillectomy is the most commonly performed surgical procedure. Careful assessment of patients must be performed, especially in females older than twenty in whom the frequency of bleeding is higher, possibly due to a hormonal effect. The increase in the intensity of pain a few hours prior to the onset of bleeding may give a warning to start therapy that may abort the bleeding

Canal wall down mastoidectomy and causes of failure review of 25 patients

To study the causes of failure [canal wall down] mastoidectomy procedure. A prospective case series study. ENT department, Al-Jamhory Teaching Hospital during the period of May 1996 to May 2000. Twenty five patients underwent canal wall down operation over a period of four years. They were reviewed for the final result after the operation. Fifteen patients were noticed to have complete dryness and healing. Eighty percent of the patients get dry ear within the first three months after the operation. Failure to get healed cavity was seen in patients with large cavities, high facial ridge and inadequate meatoplasty. Recognition of the possible causes of failure to get dry ear, the surgeon's experience and the regular follow up of the patient, may help in achieving better results

Hoarseness in Iraqi patients. Causes and management

this study was designed to determine the causes of hoarseness in a group of Iraqi patients and to document the influence of smoking and vocal abuse in the development of laryngeal pathologies. one hundred and sixteen patients presenting with hoarseness were evaluated at Al Zahrawi Teaching Hospital during the period from September 2000 to August 2001. there were 68 [58.6%] males and 48 [41.4%] females. The average age was 40 years. Cancer of the larynx was the most common cause of chronic hoarseness [38.8%], while acute laryngitis was the predominant diagnosis in acute hoarseness [64.5%]. Overall cancer of the larynx was the most frequent diagnosis being diagnosed in 33 [28.4%] of the patients. Smoking was found to be significantly related to the development of cancer of the larynx [p<0.001] and chronic laryngitis [p<0.05]. Vocal abuse had a significant relationship with the development of chronic laryngitis, vocal cord nodule, and Reink's edema. malignancy is an important cause of chronic hoarseness in Iraqi patients. Smoking is an important risk factor for malignancy. Smoking and vocal abuse are important risk factors in the development of hoarseness

Direct laryngoscopy: a prospective study

Prospective clinical analysis of direct laryngoscopic procedures performed in Mosul Teaching Hospital Iraq. Patients and 100 direct laryngoscopic procedures performed in the period from September 1996 to June 1997. There were 55 males and 45 females. The average age was 42.8 years. The most common surgical indications were hoarseness [77%] and tumor-like mass detected on indirect laryngoscopy [38%]. Laryngeal squamous cell carcinoma [SCC] was the most common final diagnosis in the malignant cases. Chronic nonspecific laryngitis was the most common benign diagnosis. The diagnostic accuracy of indirect mirror laryngoscopy compared to direct laryngoscopy was 61%. The diagnostic accuracy of direct laryngoscopic findings and histological diagnosis was 87%. Direct laryngoscopy was difficult in 3 patients, those with short and muscular neck structure. The incidence of major complications was at least 4%. Minor complications occurred in 7% of the patients. Laryngospasm was significantly higher in patients who underwent direct laryngoscopy along with other procedures than in those who underwent direct laryngoscopy alone. Conclusions: Direct laryngoscopy was performed most often indicated for chronic hoarseness and tumor-like masses detected on indirect laryngoscopy. Laryngeal SCC was the most common malignancy and chronic nonspecific laryngitis was the most common non-malignant finding. The incidence of major complications was 4%. Laryngospasm was significantly higher in patients who had undergone procedures in addition to direct laryngoscopy. It is felt that patients who undergo direct laryngoscopy are most safely managed as in patients for 24 hours

Maltreated or neglected squamous cell carcinoma

Squamous cell carcinoma [SCC] is a common skin cancer and if not treated adequately can be associated with significant morbidity and high mortality. We present one case with extensive SCC of the scalp requiring palliative surgery

Effect of maternal administration of acetaminophen on the development of rat embryos

Acetaminophen a popular nonprescription analgesic-antipyretic drug, wasadministered orally to pregnant rats at a dose levels of 0 [control], 25, 50,100, 200 and 400 mg/kg/day on day 1 to 15 gestation. The dams were sacrificedon the day 21 of pregnancy and the fetuses were removed by cesarean sectionand examined. Body weight showed evidence of maternal toxicity as exhibitedby marked increase in liver weight and decreased body weight gain. Noincrease in the incidence of resorptions was observed even at 400 mg/kg, adose several-folds higher than those used in human clinical practice [10- 20mg/kg]. There was a dose-related decrease in fetal body weights which wasstatistically significant at 200 mg/kg or more. Examination of the fetusesrevealed insignificant increase in the incidence of gross, skeletal andinternal malformations at any dose level in comparison with the controls. However, one of the fetuses in the group which received 400 mg/kg showed shorttail and club foot. Thus, no evidence of embryocidal and teratogenic effectswas observed with this analgesic-antipyretic drug at the recommendedtherapeutic dose in rats. Acetaminophen may be considered the safestanalgesic- antipyretic drug during pregnancy

Aluminum related encephalopathy in uremic patients on haemodialysis

The role of aluminum as a causative agent of encephalopathy in uremic patients on haemodialysis, and the effect of lowering serum aluminum level by the chelating agent deferoxamine [DFO] in improving clinical and electroencephalographic [EEG] features of dialysis encephalopathy [DE] was evaluated in eight patients with dE. This work was carried out on [10] control persons and [32] uremic adult patients on hemodialysis [HD] and receiving aluminum containing phosphate binder to prevent hyperphosphatemia. Patients were divided into three subgroups according to the duration of haemodialysis. The first subgroup [10] patients who have been on [HD] for a period up to 6 months. Second subgroup [10] patients who have been on HD for 6-12 months. The third subgroup [12] were on [HD] for more than 12 months up to 6 years. All patients underwent neurological examination and a waking EEG. We diagnosed dE only in the presence of the typical EEG, charges with or without manifest clinical symptoms. Thirteen [20%] patients under study showed clinical and/or typical EEG signs of DE. Five of the 13 patients developed serious clinical deterioration which led to death of four of them. Four of the remaining patients with DE showed both clinical and EEG signs, while the remaining four showed only EEG signs. Comparatively the serum alminum [SAL] level in patients with dE was significantly higher than in patients without neurologic dysfunction [p<0.05]. After the DFO infusion test, there was a significant high increase in SAL levels in DE patients when compared with those without [t = 5.4, P<0.05]. In our patients with SAL over 100 micro g/L the prevalence of DE was unexpectedly high when this neurological disorder was carefully investigated. We conclude that regular and continuous monitoring of SAL levels both basal and after DFO test, is of considerable value in detecting those patients at risk for DE and that regular EEG recordings, at least every six months, for all patients with serum level > 100 micro g/L is a sensitive method of detecting subclinical DE. Although DFO therapy has been applied to a limited number of patients in this study, we believe that it offers an effective treatment for DE, hoping that this disorder be a disease of the past